NCQA LTSS Distinction — Frequently Asked Questions
Last updated: April 2026
Answers to the most common questions about NCQA Long-Term Services and Supports (LTSS) Distinction, state requirements, standards, and IHS consulting support.
What is NCQA LTSS Distinction?
NCQA Long-Term Services and Supports (LTSS) Distinction is a specialized recognition module for NCQA-accredited health plans that coordinate long-term services and supports for Medicaid managed care populations. It evaluates whether health plans have the infrastructure, processes, and partnerships to effectively coordinate LTSS for elderly members and members living with disabilities. It is an add-on to NCQA Health Plan Accreditation — not a standalone accreditation.
Which states require NCQA LTSS Distinction?
As of the most current data available, nine states require their Medicaid managed care plans to earn NCQA LTSS Distinction. Forty-nine MCOs across fifteen states currently hold the Distinction. States that intend to require LTSS Distinction must add the LTSS Distinction module to their Medicaid managed care contract requirements. Health plans should verify current requirements with their specific state Medicaid agencies, as the list of requiring states has expanded over time.
Is LTSS Distinction a standalone accreditation or an add-on?
LTSS Distinction is an add-on module to NCQA Health Plan Accreditation (HPA). Health plans must hold current NCQA HPA or be pursuing HPA concurrently to be eligible for LTSS Distinction. A health plan cannot earn LTSS Distinction without also holding or earning NCQA Health Plan Accreditation. IHS works with plans on both HPA and LTSS Distinction simultaneously when needed.
What are the five core standard domains in NCQA LTSS Distinction?
The five core domains are: (1) Person-Centered Care Planning — developing care plans that reflect the member's goals, preferences, and values with active member involvement; (2) Care Transitions — managing transitions between care settings with documented protocols and follow-up processes; (3) Coordination of Services — coordinating the full array of medical and social services including HCBS, personal care, and behavioral health; (4) Critical Incident Management System — identifying, tracking, investigating, and responding to critical incidents including abuse, neglect, and serious adverse events; and (5) Qualifications and Assistance for LTSS Providers — verifying LTSS provider qualifications and providing support for effective service delivery.
How does NCQA LTSS Distinction align with federal Medicaid requirements?
LTSS Distinction directly aligns with LTSS provisions in the 2016 CMS Medicaid managed care rule and supports reporting on key measures in CMS's HCBS Quality Measure Set. It also addresses requirements introduced in CMS's 2024 Medicaid Access final rule related to HCBS access, quality, and reporting. Health plans that earn LTSS Distinction receive a structured framework for meeting multiple federal LTSS-related requirements in an integrated way.
What does NCQA mean by "person-centered" care planning in the LTSS context?
Person-centered care planning means that care plans are developed with active participation by the member — not merely for the member. The member's own goals, values, preferences, and definition of a good quality of life must drive the care plan content. Standards require member and caregiver involvement in care planning, regular plan review and updating, and that the care plan functions as an active coordination document rather than a static enrollment record.
What types of critical incidents must health plans track under LTSS Distinction standards?
NCQA's critical incident management standards require tracking of incidents including abuse, neglect, exploitation, and serious adverse events affecting LTSS members. Plans must have systematic processes for identifying, reporting, investigating, and responding to incidents; for notifying appropriate state authorities consistent with mandatory reporting requirements; and for conducting root cause analysis of serious events and translating findings into care process improvements.
How does LTSS Distinction address coordination of home and community-based services (HCBS)?
The Coordination of Services domain specifically requires that health plans coordinate HCBS — not just medical care. Care coordinators must have access to real-time information about HCBS authorizations and delivery, coordination processes must extend to HCBS providers, and plans must have documented processes for managing HCBS service gaps and provider capacity issues. The standards reflect that effective LTSS management requires integrating social services and community supports with clinical care.
Do dual eligible special needs plans (D-SNPs) need LTSS Distinction?
D-SNPs that coordinate LTSS for their members are strong candidates for NCQA LTSS Distinction. D-SNPs serving populations that receive Medicaid LTSS benefits — including home and community-based waiver services and institutional care — benefit from the structured LTSS coordination framework. In states that require LTSS Distinction for Medicaid MCOs, D-SNPs operating those Medicaid contracts are subject to the requirement.
How are LTSS provider qualification standards different from standard network credentialing?
Standard network credentialing addresses licensed practitioners — physicians, nurses, behavioral health professionals. LTSS provider qualification standards address a broader set of providers: home health agencies, personal care agencies, adult day programs, transportation vendors, and individual personal care attendants — often licensed under different state regulatory frameworks. LTSS Distinction requires qualification verification and oversight processes that address the specific regulatory and quality requirements for each LTSS provider type.
What are the most common gaps health plans encounter when pursuing LTSS Distinction?
Common gaps include: person-centered care planning processes that are formally compliant but not genuinely member-driven; care transition protocols that exist for hospital-to-home transitions but are undocumented or inconsistent for other transition types; coordination of services documentation that covers medical care but does not extend systematically to HCBS providers; critical incident management systems that track incidents but lack root cause analysis and process improvement connections; and LTSS provider qualification processes that are informal or inconsistently applied across provider categories.
Can a health plan pursue LTSS Distinction at the same time as NCQA Health Plan Accreditation?
Yes. Health plans entering the LTSS Distinction program for the first time can pursue NCQA Health Plan Accreditation and LTSS Distinction concurrently. IHS supports dual-track engagements and helps plans identify shared documentation infrastructure and process requirements that satisfy both programs, minimizing duplication of effort.
How does IHS approach NCQA LTSS Distinction engagements?
IHS conducts a gap assessment across all five LTSS Distinction standard domains in the context of the health plan's NCQA HPA status, develops a prioritized remediation roadmap, provides direct support for policy development and process design in priority areas, conducts a mock survey against current LTSS standards, and supports the plan through the active survey and state Medicaid contract alignment. Every engagement is led by Thomas G. Goddard, JD, PhD — former Chief Operating Officer and General Counsel of URAC.
Questions About NCQA LTSS Distinction?
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